Emma Poroger Sentencing Memo

Case 1:11-cr-00742-DLI Document 117 Filed 04/11/15 Page 1 of 27 PageID #: 591
UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK
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UNITED STATES OF AMERICA,
:
:
- against EMMA POROGER

Defendant
11-CR-742 (DLI)
:
:
:
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MEMORANDUM IN AID OF SENTENCING
CREIZMAN PLLC
Eric M. Creizman
Melissa Madrigal
565 Fifth Avenue, 7th Floor
New York, New York 10017
Telephone: (212) 972-0200
Facsimile: (646) 200-5022
Attorneys for Emma Poroger
April 10, 2015
TABLE OF CONTENTS
Page
PRELIMINARY STATEMENT ....................................................................................... 1
PERSONAL BACKGROUND ......................................................................................... 3
I. Childhood............................................................................................ 3
II. Devotion to Family and Friends......................................................................... 4
III. Medical Training............................................................................................... 7
IV. Devotion to Patients.......................................................................................... 8
V. Severe Health Problems..................................................................................... 9
VI. Fall From Grace ............................................................................................... 10
THE OFFENSE CONDUCT. 12
THE GUIDELINES CALCULATION.. 13
ANALYSIS OF AN APPROPRIATE SENTENCE UNDER 18 U.S.C.
3553(A)....................................................................................................... 18
CONCLUSION... 25
We respectfully submit this memorandum on behalf of Dr. Emma Poroger in connection

with her sentencing before Your Honor scheduled for Tuesday, April 21, 2015, at 10 a.m. Dr.
Poroger entered a guilty plea to a single-count superseding information charging her with
conspiracy to commit health care fraud, in violation of 18 U.S.C. 1347, pursuant to a plea
agreement almost three years ago, on May 2, 2012.
PRELIMINARY STATEMENT
Emma Poroger stands before this Court for sentencing as a broken woman, who, at the
relatively young age of 59, believes that she has little to enjoy or strive for and that her future is
bleak. In a period of just over three-and-a-half years, this criminal prosecution has sapped her of
her savings, stripped her of a career in medicine, divested her of her home, and constrained her
liberty, including her freedom to travel. The stress and remorse that Dr. Poroger has experienced
as a result of this case have taken their toll on her physical and psychological health. As detailed
in the reports prepared by the Probation Department, Dr. Poroger struggles with hypertension
and multiple cardiac conditions, physical disabilities due to lower back and pelvic pain, vision
impairments, and chronic vertigo, among other conditions. She often relies on a cane to walk,
and takes numerous medications on a daily basis. Dr. Poroger also suffers from severe
depression and anxiety, has experienced suicidal ideation, and has been hospitalized for suicidal
behaviors. Her declining physical and mental health led to the deterioration of a committed
relationship with her lover. The impact of this criminal case has had such a devastating impact
on Dr. Porogers life that a sentence of imprisonment is simply unnecessary for any deterrent
purposes or punishment. The objectives of federal sentencing have already been satisfied during
the three-and-a-half years Dr. Poroger has served under pretrial supervision.
A non-custodial sentence is warranted not only because of the negative consequences Dr.
Poroger has endured as a result of her wrongdoing, but also, if not more so, because of her
affirmative efforts to accept responsibility for her wrongdoing and to cooperate with the
government in its investigation. Her conduct in this regard is detailed in the governments letters
to the Court dated August 15, 2012, September 28, 2012, and April 3, 2015, which were
submitted under seal in support of the governments motion in connection with Dr. Porogers
sentencing, as well as in status updates to the Court in letters dated November 7, 2013, February
24, 2014, October 28, 2014, January 30, 2015, and February 20, 2015. Dr. Poroger has
demonstrated, through her actions, her substantial remorse for her participation in the offense,
and her commitment to redress the harms caused by the members of the health care fraud
conspiracy. Her lengthy, spotless record of compliance with all of the conditions of her pretrial
release, also establishes that she presents no risk of recidivism and that she will continue to be a
law-abiding, productive member of society as she has been over the vast majority of her life.
Given Dr. Porogers constructive behavior since her arrest, and the serious consequences
she has faced as a result of this prosecution, the mitigating factors concerning Dr. Porogers
relative culpability in the offense also compel the conclusion that a non-custodial sentence is
sufficient, but not greater than necessary to achieve the goals of sentencing. Specifically, there
is no dispute that while working at the North Austin clinic, Dr. Poroger sincerely cared for her
patients, performed procedures that she believed were medically necessary, regularly worked
twelve to fourteen hour days, and honestly reported the treatments she provided to her office
management and the billing company. She never sought to bill Medicare for treatments that
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were unnecessary or for treatments that were not performed, and was unaware of the massive
scope of the fraudulent billing to Medicare until after she began cooperating with the
government. She did not plan the fraudulent scheme, did not support it, and did not seek to
profit from it. What Dr. Poroger admittedly did wrong, is that, in September 2008, less than six
months before she left the North Austin practice, she discovered that office management and the
billing company had submitted a fraudulent bill for a test that had not been performed. At that
point, she was on notice that fraudulent bills were likely being submitted under her name and
nevertheless continued to treat patients at the North Austin Facility, and never reported the
fraudulent billing to Medicare or law enforcement. Nor did she undertake any investigation to
determine the extent of the fraudulent billing or take sufficient action to prevent further
fraudulent billing. Dr. Porogers severe lapse in judgment constitutes a significant offense, but
in light of her productive conduct since her arrest and the severe price she has paid for her
wrongdoing, we respectfully submit that a non-custodial sentence is warranted here.
PERSONAL BACKGROUND
I.
Childhood
Dr. Poroger, who is 59 years old, was born and raised in Chernovtsy, Ukraine. Her
father, Nusim, was a hat-maker, and her mother, Khayka, now deceased, a military sales woman.
(PSR 23). As a child, Dr. Poroger was raised in a middle-income household. (PSR 24).
Although all of her economic needs were met while growing up in the former Soviet Union, Dr.
Poroger was the victim of religious persecution because of her Jewish faith. Id. Other children
beat and abused Dr. Poroger as punishment for her religious identity. Id.
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II.
Devotion to Family and Friends

Dr. Poroger has one son, Feliks Koyfman, a 37 year-old physician who resides in
Mineola, New York. (PSR 25). Feliks was born in Chernovtsy, Ukraine to the marital union
of Dr. Poroger and Aleksandr Koyfman. Dr. Poroger and Dr. Koyfman divorced but they
continue to share a friendly relationship. Id. On December 22, 1992, Dr. Poroger and Feliks,
then 14 years old, emigrated from Ukraine as religious refugees and legally entered the United
States where they settled in Brooklyn, New York. (PSR 27).
As described by one of the many letters submitted by Dr. Porogers supporters to the
Court, Dr. Porogers life story is not unlike many other immigrants. She came to this country in
refuge of a bright future for her son. (Ex. A). After arriving in the United States, Dr. Poroger
worked cleaning houses in Brooklyn for approximately 9 months to provide for her family. (PSR
51). Dr. Porogers goal was to do everything possible to help her son to achieve and excel
(Ex. B) which Feliks clearly accomplished as evidenced by the fact that he followed his mothers
positive influence and became a physician. My Mother is directly responsible for my
successshe instilled in me from an early age that hard work, integrity, perseverance, and
honesty are the keys to a full life and successful career. (Ex. C).
Emma Porogers mother, Khayka, died at the age of 60 from psoriasis of the liver. (PSR
23). Khayka lived through Nazi occupation and concentration camps in the difficult post war
Russian system and was infected with a virus while working at a labor camp. Emmas goal in
life was to help her motherShe did become a doctor but too late to help her mom. (Ex. D).
Dr. Poroger is the principal caretaker of her father who is 93 years old. (PSR 23).
Nusim, her father, suffers from a myriad of health problems associated with his advanced age.
Dr. Poroger provides a significant amount of medical care and assistance to her elderly father on
a daily basis. Id. Similarly, Dr. Poroger helps care for Riva, her stepmother, who is 86 years of
age and also suffers from a myriad of health ailments associated with her advanced age. Id.
Because Dr. Poroger is the principal provider to Nusim and Riva, no one else can quite fill her
shoes in this regard if she is sentenced to prison.
In his letter to the Court, Nusim writes, she has practically returned me from the other
side several times. I have been battling bladder cancer and going through chemotherapy. And
only Emmas patience and dedication to my treatment helped me stay alive. (Ex. E). Nusim
describes how Dr. Poroger visits him daily to check his vital signs, cook for him, and take him to
his appointments. Nusim felt compelled to tell the Court I survived the Holocaust, but lost
almost my entire family. [My daughter] is my family and my life; please dont take her away
from me. Id.
In their letters to the Court, family members express grave concerns for Emmas father if
Dr. Poroger is unable to care for him. (Ex. F); (Ex. G); (Ex. H) ([Nusim] has suffered several
falls in this past year, and after each one Emma would rush to his side, caring for him, cooking
his favorite meals, and tending to his injuries. With Emma in prison, I am very concerned for
my grandfathers welfare since my father and I live in Toronto.) Dr. Porogers nephew, Igor
Poroger, who is a barrister in Ontario, tells the Court [Emma] has consistently aided [my]
elderly grandfather with [his] medical needs throughout the years. Without Emma around, it is
uncertain how my 93 year old grandfather will manage on a day to day basis. (Ex. I).
Almost all of the letters to the Court use the world selfless to describe Emma Poroger.
(Ex. J). Monika Paroder recounts when her father, who is Dr. Porogers cousin, was diagnosed
with cancer: The following months were a tumultuous whirlwind of fear, hope, anger, and
painduring this time, Emma was the voice of optimism; Emma was the voice of knowledge;
Emma was the voice of hope. She was a solid stone for us to lean against. (Ex. A). Similarly,
Aleksandr Koyfman, Dr. Porogers ex-husband, who has battled 3 forms of cancer describes
Emma was there for me during those tough times, frequently visiting me in the hospital and
helping me [get] through chemo and radiation treatments. (Ex. K). When family friend Lyuba
Lebedevas mother was diagnosed with stage 4 pancreatic cancer, Dr. Poroger was one of the
first people to reach out to Lyuba with words of support and advice. (Ex. L).
Sema Krichman describes how Emma Poroger routinely finds time to check in and give
necessary advice to Sema regarding her 92 year old mother. (Ex. M). Dr. Poroger helps those in
need: (i) driving a friend to do groceries after Hurricane Sandy hitotherwise Alla would not
have had any means to get the products home (Ex. N); (ii) driving pregnant friend Irina to her
doctors appointments (Ex. O); (iii) indefinitely opening her home during Hurricane Irene to the
Ozeryan family who did not have a safe place to stayDr. Poroger drove from Staten Island to
Coney Island to pick them up (Ex. P); (iv) traveling a long distance to friend Elenas house on a
late Friday afternoon to give Elenas son an injection to treat poison ivy (Ex. Q).
III.
Medical Training
While living in Ukraine, Dr. Poroger attended Chernovtsy Medical School and graduated
in 1978 as a qualified medical doctor. (PSR 39). Anatoly Goldenfeld recalls the
discrimination against Jewish people in terms of admission to medical school, but describes how
Dr. Poroger not only successfully completed medical school but did so as one of the best
students at Chernovtsy. (Ex. R). Dr. Poroger worked as a physician in Ukraine from 1978 to
1992: (i) chief of the emergency division of Storozhynets Hospital (1978-1982) (PSR 52); and
(ii) internal medicine physician for the Chernovtsy District Psychiatric Hospital (1982-1992)
(PSR 53). At the age of 42, and less than 5 years after emigrating from Ukraine with her
young son, Dr. Poroger attended medical school once more, this time at the New York College
of Osteopathic Medicine in Old Westbury, New York. (PSR 27). As Dr. Porogers nephew,
Igor, observed Emmas ethos for hard work and determination has been an inspiration to those
around her. She put herself through medical school, well into her middle age, and never asked
for any help from anyone. (Ex. I). Emma attended English classes when she first moved to the
United States and as family friend, Denis Shtabel recalls, During the late 90s when I would
visit her home, I would see stacks of medical books, notes, diagrams, and English/Russian
dictionaries opened and being used in every room and on every desk/table of her house. She was
immersed in studying. (Ex. S). In 2000, Dr. Poroger completed medical school and undertook a
medical internship and residency in New Jersey. (PSR 27). Dr. Poroger secured licenses to
practice medicine in New York, New Jersey, and Florida and also achieved board certification by
the American Osteopathic Board of Family Medicine. (PSR 38).
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IV.
Devotion to Patients
Dr. Porogers patients admire and respect her, which is reflected by the many letters to
the Court from patients who have stood by Dr. Poroger during the last four years since her legal,
financial, and personal circumstances deteriorated. At the time of her arrest, Dr. Poroger ran a
private medical practice, Penfel Medical, PC, with two offices: (i) Jersey City, New Jersey; and
(ii) Staten Island, New York. (PSR 40). After her arrest, insurance companies began to steadily
drop Dr. Poroger as a covered medical provider and neither of her offices was able to earn a
profit. Dr. Poroger kept the offices open, albeit on a part-time basis, and operated at a loss
because she believed in serving her patients who relied on Dr. Porogers care. Id.
What really sets Dr. Poroger apart from the norm is her unparalleled compassion and
respect for her patients. Leonid Katsman, a longtime patient of Dr. Poroger, echoes these
sentiments. Dr. Poroger has demonstrated the utmost respect for me as a patient and I have
on many occasions witness[ed] her compassion, care, and courtesy in treating other patients.
(Ex. T). As Yaniris Candelaria, a medical assistance who worked with Dr. Poroger for many
years recounts, The time I have spent in her office, I could understand why her patients loved
her so much. She was very attentive and concerned about not only their medical needs, but to
their needs as people. (Ex. U).
Dr. Poroger made a difference in the lives of many patients. (Ex. V). Izabella Genin, a
patient of Dr. Poroger recounts how she met Dr. Poroger in a difficult time of her life. It was
after a car accident with a drunk driver in which I sustained serious injuries that greatly affected
my personal and professional life. Under the devoted and exceptional care of Dr. Poroger, I was
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able to continue working until my retirement and be free from pain in my everyday activities.
(Ex. W).
According to Tatyana Katsman, Doctor of Osteopathic Medicine, and colleague to Dr.
Poroger over the years I have seen Dr. Poroger serve her patients to a degree that is compared to
none. (Ex. X). Dr. Poroger is known to answer her patients calls to her cellular phone 24
hours a day, 7 days a week. (Ex. Y); (Ex. Z).
V.
Severe Health Problems

Since her arrest, Dr. Poroger has suffered from a myriad of physical and mental health
problems, which are well documented in the PSR and the Addendums to the PSR. Beginning in
January 2011, Dr. Poroger fell into a severe depression and began to experience suicidal
thoughts. In March 2011, Dr. Poroger sought treatment for her depression attending regular
therapy sessions with a psychiatrist. In January 2013, Dr. Poroger was diagnosed with major
depressive disorder and anxiety disorder, with severe helplessness and hopelessness. (Second
PSR Addendum). As a result, Dr. Poroger takes multiple daily medications to treat her anxiety
and depression. Id. Dr. Poroger also attends biweekly psychotherapy sessions in addition to the
psychotropic medications she takes regularly. (Ex. AA). Dr. Poroger has expressed to her
pretrial services officer that she will not survive if she has to go to prison and doesnt know
how she will go on. (Second PSR Addendum). Dr. Porogers son reported that prior to her
arrest, she did not suffer from any mental health or emotional problems. (PSR 31).
In addition to her mental health and emotional problems, Dr. Poroger has been diagnosed
with a number of conditions for which she takes a significant amount of prescription medication.
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(Second PSR Addendum). In 2011, Dr. Poroger underwent surgery as a preventative measure
due to the discovery of pre-cancerous cells. (PSR 33). In 2012, she was diagnosed with
multiple cardiac conditions, including hypertension and severe diastolic heart failureconditions
which prevent her from working full time and which require regular medical care. (Second PSR
Addendum). In 2012, Dr. Poroger was also diagnosed with chronic severe low back pain and
pelvic pain due to lumbar-sacral spondylitis, which prevents Dr. Poroger from walking for more
than 20 minutes or sitting for more than 40 minutes. Id. She was also diagnosed in 2012 with
pituitary adenoma and chronic hypertensive vascular changeswhich rendered her functionally
significantly disabled and practically disable[d]. Id; (Ex. BB). Dr. Poroger receives
acupuncture treatments regularly to combat migraine headaches, dizziness, vertigo, insomnia,
anxiety, depression, constipation, incontinence, tinnitus, pain in the neck, lower back, shoulders,
knees, legs and feet. (Ex. CC). Due to Dr. Porogers severe medical problems and resulting
disability, she stopped working in December 2012 and began to draw disability payments from
her life insurance company. (Second PSR Addendum).
VI.
Fall From Grace

Since her arrest in the instant offense, Dr. Poroger has suffered debilitating loss in
multiple aspects of her life: health wisementally, emotionally, and physically; financially; and
professionally. According to Dr. Porogers psychiatrist, Dr. Isakov, Dr. Poroger fears to be left
alone, has become isolative and withdrawn since her legal issues began, and she has lost
interest in life [] frequently expressing her desire to end her life and end her suffering. (Ex.
AA).
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For example, in his letter to the Court, Bezenchuk, Dr. Porogers stepbrother, writes
You cannot imagine [Emmas] sadness and remorse in her lapse in not following [her] values.
(Ex. F). Your Honor, it is hard for me to explain how much she has already been punished.
Emmas health has deteriorated significantly over the past years. She is filled with anxiety and
depression which has exacerbated her chronic medical conditions. (Ex. G). Koyfman similarly
observed Knowing Emma as well as I do, I can see the toll this ordeal has taken on her. She
was a woman who was capable of working 80-100 hours a week; now she can barely walk
without a cane. However, the physical ailments are nothing in comparison to the mental anguish
she is experiencing. (Ex. K).
Dr. Isakov expressed that Dr. Porogers main source of support is her son who visits her
frequently and assures Dr. Poroger that she is safe. Id. The instant case has taken a significant
toll on Dr. Poroger. My mother was a vibrant and energetic woman, but in the last 3.5 years,
her health has significantly deterioratedHer mental health is also in serious decline. (Ex. C);
(Ex. DD). Putting aside the onset of multiple crippling health issues, the fallout from her
criminal case resulted in the loss of Dr. Porogers medical practice and her means of financial
independence. The fact that she will never again practice medicine has been an enormous
emotional burden for Emma. (Ex. DD).
A condition of Dr. Porogers plea agreement was that she forfeit her home located at 97
Giffords Lane in Staten Island (PSR 57). Additionally, Dr. Poroger was left in financial ruin
and with no choice but to file for Bankruptcy. (Second PSR Addendum). Dr. Poroger has lost
everything.
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Your Honor, I can tell you firsthand the shame, remorse and guilt my mother feels on [a]
daily basis for what she has done. She lives in misery and pain everyday, and she has
spent many sleepless nights agonizing over how this will impact the future of her family.
She knows she made a mistake and is extremely regretful for what she has done. She will
never forget what happened, and she strives every day to live a moral and honest life.
(Ex. C).
THE OFFENSE CONDUCT
From November 2006 through March 2009, Dr. Poroger served as the medical director
for North Austin Medical, P.C., a medical clinic located in Forest Hills, Queens. Poroger was
hired as medical director by the co-owner of a billing company called Claim Torrent, Inc. The
North Austin office was managed by Queens North, Inc. During Dr. Porogers tenure at North
Austin, approximately $13 million was billed in claims to Medicare under her Medicare provider
number, of which approximately $4 million was paid. A Significant portion of the $13 million
billed to Medicare was resubmissions of claims previously denied. Although Dr. Poroger signed
an enrollment application that was submitted to Medicare in which she certified that all claims
submitted under her provider number would be true, accurate, and medically necessary, Dr.
Poroger left the task of submitting bills to Queens North and Claim Torrent.
Nevertheless, Dr. Poroger would provide Queens North and Claim Torrent with an
accurate statement of the treatments she provided with accurate coding. There is no dispute that
Dr. Poroger honestly treated her patients to the best of her ability, performed services that she
believed to be medically necessary, and never submitted fraudulent accounts of her treatments to
patients. She relied on the assurances of Queens North and Claim Torrent that the bills that
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would be submitted to Medicare would accurately reflect the services she provided and the codes
that she assigned to those services.
In September 2008, only about six months before she left North Austin, Dr. Poroger
discovered that an electrocardiogram test was ordered for a patient without her knowledge or
approval. She also noticed that around that time period, revenues increased significantly without
any noticeable change in the number of patients she treated or the number of hours that she
worked. At that point, Dr. Poroger became aware of circumstances that strongly indicated that
her office manager and billing company were engaged in fraudulent billing. Although Dr.
Poroger chastised her office manager for ordering and billing for the unnecessary test, she did
not investigate whether fraudulent billing continued. She took no corrective measures to prevent
fraudulent billing and did not inform law enforcement or Medicare of her discoveries. It was
only after her arrest, when she began cooperating with the government, that she learned of the
substantial scope of the fraudulent scheme.
THE GUIDELINES CALCULATION
A district court should begin all sentencing proceedings by correctly calculating the
applicable Sentencing Guidelines. See United States v. Crosby, 397 F. 3d 103, 112-13 (2d Cir.
2005). The defense agrees with the government and the Probation Department that the
applicable Guidelines Manual in effect is the 2009 Guidelines. See PSR 10. Furthermore, the
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defense agrees that the base offense level applicable to the offense is 6 and that a two-level
enhancement for abuse of a position of trust is warranted under Section 3B1.3.1 The defense,
however, strongly disputes the government and Probations calculation of loss under Section
2B1.1, which asserts that a 20-level enhancement is warranted for a loss of over $13 million. See
U.S.S.G. 2B1.1(b)(1)(K).
It is well established that loss under the Guidelines need not be established with
precision, and the Court, in determining the loss, need only make a reasonable estimate of the
loss, given the available information. United States v. Uddin, 551 F.3d 176, 180 (2d Cir. 2009).
Nevertheless, a reasonable estimate may not be based on pure speculation. United States v,
Deutsch, 987 F.2d 878, 886 (2d Cr. 1993). Nor can a flawed methodology that is the basis of an
asserted loss amount satisfy the reasonable estimate standard. See United States v. Cuti, 2011
WL 3585988, at *6 (S.D.N.Y. July 29, 2011) (holding that government failed to meet its burden
in establishing loss because it refused to consider other relevant data and methodologies in
arriving at its loss figure). Indeed, a loss calculation must be based on clearly articulable
conclusions and assumptions based upon evidence in the record and subject to evaluation by the
1 The parties previously have submitted substantial briefing on the calculation of loss and on the
potential enhancement for abuse of trust. See Dkt. ## 63, 64, 65, 68, 74, 76, and 77. In reviewing
the Guidelines submissions, current counsel departs from the position of previous defense counsel as
to the applicability of the two-level enhancement for abuse of trust under Section 3B1.3. We
concede that decisional authority supports the position of the government and Probation that the
enhancement is warranted under the facts and circumstances of this case. However, we dispute the
government and Probations calculation of loss under Section 2B1.1 for the reasons set forth herein.
14
defendant. See, e.g., United States v. Hartstein, 500 F.3d 790, 796 (8th Cir. 2007) (vacating
sentence and remanding where government presented summary tables regarding an accounting
of the fraudulent loans at issue in the case, but the tables were based on evidence that was neither
before the court nor available to the defense to evaluate).
The loss calculation advanced by the government and Probation of $13 million lacks a
coherent methodology with respect to Dr. Poroger and is fundamentally flawed. First, the $13
million figure is based on the total amount billed by North Austin to Medicare from October
2006 through March 2009. See PSR 5; Dkt. ## 64, 73. This calculation improperly assumes
that all billing was fraudulent, notwithstanding that even the government must concede that
legitimate services were performed for patients at North Austin. Thus, the governments loss
calculation ignores that a significant portion of the amount billed to Medicare was for legitimate
services.
Second, the government does not dispute that Dr. Poroger first discovered fraudulent
billing to Medicare in September 2008. At that time, she learned that an electrocardiogram was
ordered and billed without her authorization. The government does not contend that Dr. Poroger
knew at the time that the managers of the North Austin clinic and the billing company had been
altering her accurate reports of the treatments she provided, and submitted bills to Medicare that
overstated the extent of the services performed and included services that were never performed.
In these circumstances, Dr. Poroger cannot, for Guidelines purposes, be held accountable for
fraudulent billing pre-dating September 2008 because the scope of the fraudulent billing
committed by her co-conspirators was not reasonably foreseeable to her. See, e.g., Familglietti v.
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United States, 2010 WL 996004, *2 (S.D.N.Y. Mar. 12, 2010) (A defendant convicted of
conspiracy is properly held liable for all of the victims reasonably foreseeable losses); United
States v. OCampo, 973 F.2d 1015, 1024 (1st Cir. 1992) ([T]he concept of foreseeability (a
forward looking concept) must be turned around 180 degrees [to] be applied to the conduct of
co-conspirators occurring before the entry of a particular defendant into the conspiracy.);
Bryant v. Mattel, Inc., 2010 WL 3705668 (C.D. Cal. Aug. 2, 2010) ([A] conspirator cannot
reasonably foresee his co-conspirators commission of overt acts prior to his entry into the
unlawful agreement.).
In these circumstances, the appropriate time period to evaluate the loss properly
attributable to Dr. Poroger under the Guidelines is September 2008 through March 2009. During
that time period, $2,458,440.91 was billed to Medicare under Dr. Porogers Medicare PIN that
was associated with North Austin. See Dkt. #73 at 1. That loss figure should be reduced by the
amounts billed for legitimate services performed, and further by the $25,000 that Dr. Poroger
voluntarily returned to Medicare during its audit of North Austin, prior to her indictment. See
Dkt. #74 at 5-8. Assuming, however, the offsets do not bring the loss figure below $1,000,000,
the appropriate loss calculation, even using the total amount billed from September 2008 through
March 2009 is less than $2.5 million, and thus, only a 16-level enhancement is warranted under
Section 2B1.1. See U.S.S.G. 2B1.1(b)(1)(I).
Accordingly, the appropriate Guidelines calculation is a level 21, which is premised on a
base offense level of 6, a loss enhancement of 16 levels, a two-level adjustment for abuse of
trust, and a three-level reduction for acceptance of responsibility. The advisory Guidelines
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sentence, given Dr. Porogers lack of any prior convictions, is therefore 37-46 months
imprisonment. For the reasons set forth in this memorandum, a downward departure under the
Guidelines is warranted because with respect to relative culpability in the offense, the loss
overstates the seriousness of the offense as to Dr. Poroger. See U.S.S.G. 2B1.1, cmt. n.
19(c). Thus, the Guidelines themselves provide a basis for a sentence below the advisory
Guidelines range. See United States v. Emmenegger, 329 F. Supp. 2d 416, 422 (S.D.N.Y. 2004)
(While some members of Congress and journalists occasionally seem to misunderstand the
concept, a sentencing departure does not constitute a subversion of the Sentencing Reform Act or
of the guidelines system. In fact, notwithstanding the shorthand terminology sometimes applied,
a departure is not a departure from the guidelines; it is a departure from the otherwise
applicable guideline range.) (emphasis in original).
Judge Rakoffs observation in imposing a below-Guidelines sentence in a recent case,
finding that the loss amount was disproportionate to the offense is particularly apt here:
Imposing a sentence on a fellow human being is a formidable responsibility. It requires a
court to consider, with great care and sensitivity, a large complex of facts and factors.
The notion that this complicated analysis, and moral responsibility, can be reduced to the
mechanical adding-up of a small set of numbers artificially assigned to a few arbitrarily
selected variables wars with common sense. Whereas apples and oranges may have but a
few salient qualities, human beings in their interactions with society are too complicated
to be treated like commodities, and the attempt to do so can only lead to bizarre results.
United States v. Gupta, 904 F. Supp. 2d 349, 350 (S.D.N.Y. 2012). See also, e.g., United States
v. Adelson, 441 F.Supp. 2nd 506 (S.D.N.Y. 2006), affd, 301 Fed. Appx. 93 (2d. Cir. 2008) (the
Sentencing Guidelines . . . in an effort to appear objective, tend to place great weight on
putatively measurable quantities, such as . . . the amount of financial loss in fraud cases, without
17
however, explaining why it is appropriate to accord such huge weight to such factors.); United
States v. Corsey, 723 F.3d 366, 380 (2d Cir. 2013) (The history of bracket inflation directed by
Congress renders the loss guideline fundamentally flawed, especially as loss amounts climb.
The higher the loss amount, the more distorted the guidelines advice to sentencing judges.).
ANALYSIS OF AN APPROPRIATE SENTENCE UNDER 18 U.S.C. 3553(a)
We respectfully submit that a sentence of probation is warranted here under the factors
set forth in 18 U.S.C. 3553(a) in order to impose a sentence sufficient but not greater than
necessary to satisfy the objectives of federal sentencing. See Rita v. United States, 551 U.S.
338, 348 (2007) (quoting 18 U.S.C. 3553(a)). Under Section 3553(a), a district court must
consider the nature and circumstances of the offense and the history and characteristics of the
defendant. Id. 3553(a)(1). Moreover, the court must impose a sentence that is sufficient, but
not greater than necessary to, in pertinent part: (i) reflect the seriousness of the offense,
promote respect for the law, and to provide just punishment for the offense. (Id.
3553(a)(2)(A)); (ii) afford adequate deterrence to criminal conduct (Id. 3553 (a)(2)(B));
protect the public from further crimes of the defendant (Id. 3553(a)(2)(C)); and (iv) provide
the defendant with needed educational or vocational training, medical care, or other correctional
treatment in the most effective manner. (Id. 3553(a)(2)(D)). In conducting this analysis, the
district court may not presume that the Guidelines range is reasonable. Gall v. United States,
552 U.S. 38, 50 (2007). Rather, it must instead conduct its own independent review of the
sentencing factors, aided by the argument of the prosecution and the defense. United States v.
Cavera, 550 F.3d 180, 189 (2d Cir. 2007). The sentencing judge has a very wide latitude to
18
decide the proper degree of punishment for an individual offender and a particular crime. Id. at
188.
First, a non-custodial sentence is warranted based on the nature and circumstances of the
offense and Dr. Porogers personal characteristics. As set forth in the governments submissions
to the Court, Dr. Poroger deserves consideration for the substantial assistance that she provided
in the investigation and prosecution of the offense. Furthermore, it is undisputed that Dr.
Poroger was a hard-working, devoted physician who never sought to steal from Medicare. Her
sole purpose was to treat patients. She did not plan the offense or actively participate in it.
Instead, she closed her eyes to the fraudulent scheme and did not take measures to investigate or
stop the fraud when she was put on unquestionable notice that wrongdoing was afoot.
Nevertheless, Dr. Poroger did not enjoy the profits of the fraud. She worked 12-14 hour
days and took a reasonable salary. Dr. Poroger lived comfortably in a home that she owned
(with a mortgage), but hardly lived a lavish lifestyle. She lived modestly and focused her free
time on caring for her parents and spending time with her son. Dr. Poroger was at most a
reluctant participant in the fraudulent scheme and her failure to take action to stop the fraud
represents a lapse in judgment over a short period in an otherwise exemplary life. Here, the
Court should exercise its substantial discretion and impose a non-Guidelines, non-custodial
sentence because the defendants commission of the instant offense[] was aberrant behavior,
although perhaps not aberrant as defined by the U.S. Sentencing Guidelines, but rather as
defined by Merriam Webster: . . . atypical. Gupta, 904 F. Supp. 2d at 354.
19
Second, a non-custodial sentence is sufficient, but not greater than necessary, to

reflect the seriousness of the offense . . . promote respect for the law, and . . . provide just
punishment. 18 U.S.C. 3553(a)(2)(A). The offense for which Dr. Poroger was convicted is
undoubtedly serious. However, as discussed in this memorandum, Dr. Poroger ultimately
suffered horrific personal, financial, and legal consequences as a result of her offense, and gained
nothing. Her culpability in the offense, for the reasons stated above, is much lower than that of
her coconspirators. Finally, in the over three years since her arrest, and the six years since the
offense, Dr. Poroger has a demonstrated a track record of following the law and abiding by all
the terms of her pretrial release.
In these circumstances, a non-custodial sentence is warranted. See, e.g., United States v.
Paul, 2007 WL 2384234 (9th Cir. Aug. 17, 2007) (within guideline sentence of 16 months (high
end) for taking government money was unreasonably high in part because Paul was a first-time
offender with absolutely no criminal record whatsoever); United States v. Edwards, 595 F.3d
1004 (9th Cir. 2010) (where defendant convicted of bankruptcy fraud and on probation for prior
state conviction for fraud, and where guidelines range 27-33 months, sentence of probation,
seven months of which was to be served under house arrest, and $5,000 fine, was not an abuse of
discretion in part because proper for judge to consider that by the time of the 2008 resentencing, the offenses had been committed nine years previously and that Edwards had left the
stress of his earlier job in the construction business that led him to become involved in the
financial fraud scheme, and completed without incident three and one half years of probation.).
20
Third, a non-custodial sentence afford[s] adequate deterrence to criminal conduct. 18

U.S.C. 3553(a)(2)(B). As a result of Dr. Porogers alleged offense: (i) she will never again be
licensed to practice medicine, (ii) her finances were devastated, (iii) her house was forfeited by
the government; (iv) her physical and mental health have substantially deteriorated; and (v) she
has spent approximately three-and-a-half year under pretrial supervision, which has involved
significant restrictions on her ability to travel. In these circumstances, one need only consider
what happened to [Dr. Poroger] in order to reconsider [committing a similar offense]; thus,
general deterrence [is] served. United States v. Redemann, 295 F. Supp. 2d 887, 897 (E.D. Wis.
2003). See also, e.g., United States v. Gaind, 829 F. Supp. 669 (S.D.N.Y. 1993) (the destruction
of a defendant's only business, involving testing material for the EPA, warranted a downward
departure in false statement case because elimination of the defendant's inability to engage in
similar or related activities and the substantial loss of assets and income were a source of
individual and general deterrence); United States v. Anderson, 533 F.3d 623 (8th Cir. 2008)
(district courts below-Guidelines sentence was not unreasonable in part because of collateral
consequences where district court specifically addressed other ways in which the defendant had
suffered atypical punishment such as the loss of his reputation and his company, the ongoing
case against him from the Securities and Exchange Commission and the harm visited upon him
as a result of the fact that his actions brought his wife and friends into the criminal justice
system.).
21
Thus, in light of the adverse consequences Dr. Poroger suffered as a result of the alleged
offense, a non-custodial sentence is more than sufficient to deter others from committing the
same offense. As the Supreme Court observed in Gall v. United States, 552 U.S. 38, 48 (2007):
We recognize that custodial sentences are qualitatively more severe than probationary
sentences of equivalent terms. Offenders on probation are nonetheless subject to several
standard conditions that substantially restrict their liberty . . . Probationers may not leave
the judicial district, move, or change jobs without notifying, and in some cases, receiving
permission from, their probation officer or the court. They must report regularly to their
probation officer, permit unannounced visits to their homes, refrain from associating with
any person convicted of a felony, and refrain from excessive drinking. Most probationers
are also subject to individual special conditions imposed by the court.
Similarly, Judge Gleeson observed in a recent opinion when a judge chooses between a
prison term and probation, she is not choosing between punishment and no punishment.
Probation is less severe than a prison term, but both are punishment. And as the Supreme Court
has recognized, probation is significant punishment. United States v. Leitch, 2013 WL 753445,
at *12 (E.D.N.Y. Feb. 2, 2013) (emphasis in original). Indeed, special conditions of probation
may include significant restrictions on liberty such as home detention. See 18 U.S.C.
3563(b)(19) (discretionary conditions of probation may include that the defendant remain at his
place of residence during nonworking hours and, if the court finds it appropriate, that compliance
with this condition be monitored by telephonic or electronic signaling devices.); United States
v. Coughlin, Crim. No-06-20005, 2008 WL 313099, at *5 (W.D. Ark. Feb. 1, 2009) (Home
detention and probation can be severe punishments, hugely restrictive of liberty, highly effective
in the determent of crime and amply retributive.).
22
Here, Dr. Poroger has experienced the equivalent of three-and-a-half years of Probation
by remaining under relatively restrictive conditions of pretrial supervision, especially for a
person without significant assets, without overseas or unaccounted-for assets, without foreign
ties, but with very strong ties to the community, and who has cooperated with the government.
Fourth, for the same reasons a sentence of probation is sufficient to achieve general
deterrence, it is also sufficient to protect the public from further crimes of the defendant.
Indeed, the personal, business and family consequences [Dr. Poroger has] experienced will
likely deter [her] from future misconduct. Redemann, 295 F. Supp. 2d at 897; United States v.
Mizrahi, 2008 WL 3009983, at *2 (E.D.N.Y. 1993) (where defendant loses his or her livelihood
and is thus prevented from engaging in similar crimes, the necessity for achieving the purposes
of sentencing through sentencing itself has been reduced.). In addition, because Dr. Poroger
will never be able to practice medicine again, she will never again be in a position to commit a
similar offense. See United States v. Speed Joyeros, 204 F. Supp. 2d 412, 440 (E.D.N.Y. 2002)
(departure appropriate where defendant is barred by the destruction of business from
committing similar future criminal acts); Gaind, 829 F. Supp. At 671 (where the defendant
loses his or her livelihood and is thus prevented from engaging in similar crimes, the necessity
for achieving the purposes of sentencing through sentencing itself has been reduced.).
Fifth, a non-custodial sentence is warranted in order to provide the defendant with
needed . . . medical care, or other correctional treatment in the most effective manner. 18 U.S.C.
3553(a)(2)(D). Dr. Poroger currently suffers from severe physical and psychiatric
impairments. Most seriously, she suffers from major cardiac conditions, impaired vision,
23
impaired movement, severe depression, severe anxiety, and suicidal ideation. She is prescribed
over 18 medications and requires frequent visits to her medical providers, who are fully familiar
with her myriad conditions and have treated her for several years. If Dr. Poroger is incarcerated,
it is substantially unlikely that Dr. Poroger will receive the health care she desperately needs for
her chronic physical and psychological conditions.
24
CONCLUSION
Accordingly, a non-Guidelines, non-custodial sentence is sufficient, but not greater than
necessary to satisfy the objectives of federal sentencing set forth in 18 U.S.C. 3553(a). For the
foregoing reasons, we respectfully request that the Court impose a non-custodial sentence.
Dated:
New York, New York

April 10, 2015
Respectfully submitted,
/s/ Eric M. Creizman
Eric M. Creizman
Melissa Madrigal
CREIZMAN PLLC
565 Fifth Avenue, 7th Floor
New York, New York 10017
Phone: (212) 972-0200
Fax: (646) 200-5022
ecreiz@creizmanllc.com
Attorneys for Emma Poroger
25
Case 1:11-cr-00742-DLI Document 117-1 Filed 04/11/15 Page 1 of 1 PageID #: 618
March 30, 2015.

The Honorable Dora L Irizarry
United States District Court Judge
United States District Court
Eastern District of New York
225 Cadman Plaza East
Brooklyn, New York 11201
Dear Honorable Judge Irizarry,
My name is Monika Paroder and I am a resident physician at New York Presbyterian- Columbia University
Medical Center, mother of two baby boys, and Emmas niece. Thus needless to explain, I have known
Emma my entire life. I would like to share with you some insight into Emmas character a selfless
dedicated woman of incredible strength, kindness, and compassion.
Almost five years ago, my life, my familys life and the world as I knew it had changed forever. My dad was
diagnosed with cancer. The following months were a tumultuous whirlwind of fear, hope, anger, and pain;
moments that will forever be vividly ingrained in my memory. During this time, Emma was the voice of
optimism; Emma was the voice of knowledge; Emma was the voice of hope; Emma was the voice of reality.
She was a solid stone for us to lean against, yet I know it was unimaginably difficult for her. Emma too lost
her mother when she was in her 20s.
Emma is my dads cousin, my aunt. In reality though, she was like his sister and more that that, she is my
moms dear friend. Her life story is not unlike many other immigrants. She came to this country in refuge of
a bright future for her son and her family. Her decision to enter the highly regarded field of medicine was
driven by the selfless, fervent desire to help people, even at her own expense. As a foreigner, she was
faced with a new culture, a new language, the challenge of starting a new life. She succeeded, like she
always did. She was a role model for me a woman with a career, a family, friends who love her.
There is one quality I love about Emma most. Emma always believes; she has faith. She sees the good in
anyone, even that bum on the corner begging for money for a family he doesnt have. She trusts people; she
is all about second chances. She doesnt question whether people have ulterior motives. She is honest and
she thinks the world is too. It is rare to encounter people of this character these days.
Emma has always been an honest woman with immense perseverance and incredibly high values. While I
know it sounds like a clich, it is in the nature of human beings to make mistakes. I truly do believe Emma
acted very much out of her character. As the Roman Philosopher Lucius Annaeus Seneca once said,
There is no person so severely punished, as those who subject themselves to the whip of their own
remorse. To say that Emma is punished by her remorse for her actions would be an understatement.
Emma is the only remaining family from my dads side that my family and I have left here in the US. Today,
your honor, I am terribly fearful that Emma may be taken away from those that love her and depend on her
and that my two little boys may not have the opportunity to get to know her and their roots. Love and
compassion are necessities, not luxuries. Without them humanity cannot survive, said the Dalai Lama. I
hope that you will show my aunt, Emma Paroger, compassion, as she has always shown to everyone in her
life, even those who dont deserve it.
I plead for you to be kind to our family and allow her to remain with us.
Respectfully,
Monika Paroder-Belenitsky, MD, PhD
March 17,2015
The Honorable Dora L.lrizarry
Dear Judge lrizarry:
My name is Matvey Nikhamin. I currently work as Senior Application Analyst at
Partners HealthCare in Boston area.
I am aware that Emma has been convicted of a crime and that you are going to
be sentencing her in connection with this crime. I would like to request as much
Ieniency as possible in Emma's sentencing.

I have met Emma about 22 years ago, soon after she and her family immigrated
to the United States. Ever since then, I have known her as a great friend to my
family and also as a mother of one of my best friends. My family and I have gone
through many of the same life-changing experiences as our families immigrated
to the United States around the same time and endured many of the same
difficulties and challenges in order to settle here. Emma and her husband, same
as my parents, had to uproot their whole lives, careers in order to come here.
Decade's worth of memories, possessions, connections and relationships were
left behind, suspended - in order to bring kids to better and safer future.
Emma, who was a doctor back in Ukraine, was determined to become a doctor
here as well. She knew how challenging and demanding the path to becoming a
doctor was. For Emma it meant going back to school, it meant learning English
and mastering it as quickly as possible in order to succeed. Any one of these is a
great challenge to an individual, but for Emma this was a challenge worth facing
and overcoming. Emma had a plan and she put forth extraordinary amount of
effort to follow through on it.
At the same time as Emma started on a path to become a doctor again, she and
her husband had to quickly learn, understand and organize future of their 15 year
old son. They were under a lot of pressure to make the best possible choices for
their son. They had to digest a lot of new and important information to make
decisions as their son entered school mid-sophomore year and he was going to
be applying to Colleges and Universities very soon. Emma, as most immigrant
parents, had a vision of better and brighter future for her son, when she made a
decision to come to the United States. Emma's goal was to do everything
possible to help her son to achieve and excel in the new country, new city, new
school, new environment.
Besides, having gone through immigration and settling, there was another life
event in Emma's life that was very close to what my family has gone through.
Emma went through divorce, just like my parents did. However, unlike my
parents Emma and her husband made sure that the divorce had as little affect on
her son as possible. Emma and her husband had strong commitment to support
their son even after separation. They collaborated together to attend his
birthdays, graduations, and a wedding. They worked together to provide him any
support he needed while he was nearby in medical school and after from a far
with frequent visits and phone calls. Being one of his best friends, I can candidly
say that his hard work, ethics, integrity are reflection of Emma's strong values.
Furthermore, over the past 22 plus years Emma has also been one of my
mother's closest friends here in United States. Emma has been a shoulder to
lean on for my mother numerous times over the years. While in the beginning
there was a lot of common challenges to overcome, over time Emma and my
mother were on different paths. A lot had to do with my mother's persistent health
issues and bitter divorce, but no matter what Emma was always there for her.
Even during these hard times after her arrest and plea, Emma always found time
to reach to my mother and check in on her to make sure she was ok. Whenever
Emma could not reach my mother after numerous calls, she would call me to find
out if I talked to her and she was ok.
For me, growing from a teenage boy, to a parent myself in the country that is my
second home I can really appreciate the effort and strength it took for Emma to
accomplish as much as she did under such trying circumstances. Emma and my
parents made this once in a lifetime decision to come to this country. ln the last
few years I have continuously tried to measure myself against my own parents
and parents of my friends - Am I courageous enough? Am I determined enough?
Do I have strength to start everything over? Do I have what it takes? - To even
entertain such decision. Emma with her husband and my parents went far
beyond just thinking about it. They did it. And, I have always felt that our parents
sacrificed some of the best years of their lives to get us here and to watch us
grow and succeed. We are forever indebted to them for it. Seeing us and our
children develop and establish ourselves is the best gift we can give them at this
time. And, for Emma who is going to become a grandmother this June - it would
be such a huge triumph to meet her future grandson, To be there when he is
born, to be there to see his first smile, to be there when he starts lifting his head,
and to be there seeing how a giant step taken some 20 odd years ago led to first
tiny baby steps - propelling new life to better and brighter future.
firmly believe in Emma's strength, integrity, perseverance, and determination to

overcome many challenges. I have seen it over the years, as I have seen Emma
rise to the occasion to accomplish and achieve things that seemed unimaginable.
She has always done it with dignity, grace and sincerity. I hope with all my heart
that Emma can avoid any jail sentence and can continue in her role as mother,
grandmother and a friend for everyone that's close.
I
Respectfully yours,
Matvey Nikhamin
Igor Poroger
22 Market Road, Flat 7 London, United Kingdom N7 9GS
Phone: +44 7449929691 E-Mail: igor.poroger@yahoo.ca

March 18, 2015

The Honorable Dora L. Irizarry

Dear Judge Irizarry,
Please accept this letter in support of my aunt Dr. Emma Poroger. I can appreciate that an
endorsement letter from a family member may not be very convincing to you, given the
inherent bias. For this reason, I write this letter as both a concerned family member and as a
fellow officer of the court. With the utmost respect for the justice system, I implore you, in
your deliberations regarding Emmas sentencing, to please consider her good character
before coming to your decision, and that incarceration does not form part of her sentence.
Emma is the type of person who will rarely say no when someone is in need. She will go
above and beyond, though in her eyes I think she is merely being herself. I know this
because she has consistently aided both my parents and elderly grandfather with their
medical needs throughout the years. Without Emma around, it is uncertain how my 93 year
old grandfather will manage on a day to day basis.
Emmas biggest flaw is that she forgets to think about herself when the interests of others
are at stake. Quite recently, Emma went out of her way for me, gathering my grandfathers
naturalization documents, as I required these for a personal immigration matter while
living abroad. This was no easy feat, as Emma had to personally escort my grandfather (who
had not left Brooklyn in several years) to Manhattan, translate various documents for
government clerks, and coordinate a complicated over-legalization process to validate the
documents for foreign use. Without Emmas help, my immigration situation would have
stalled, but I was never concerned, because knowing the kind of person my aunt is, a selfless
and dedicated individual, there was never a reason to doubt that she wouldnt come
through, or that she would not be willing to help.
Emmas ethos for hard work and determination has been an inspiration to those around
her. She put herself through medical school, well into her middle age, and never asked for
any help from anyone. Her proud nature does not allow her to fall down or pity herself, even

Page 2
throughout this tumultuous ordeal. It would be a travesty is she was to be prevented, even
temporarily, from inspiring others with her strength.
I know that Emma is truly repentant for her error in judgement, and only wants the
opportunity to care for her family and make a positive contribution to her community. I ask
you to please consider the benefits to be derived from allowing Emma to continue serving
her family and community, and reflect on what little could be gained from incarcerating
Emma, other than depriving the freedom of a good, hard working and penitent woman.

Respectfully,
Igor Poroger, B.E.S., J.D.

Barrister and Solicitor (Called to the Bar of Ontario, Canada)

Elena Bronstein
60 Holiday Ct
River Vale, NJ 07675

Dear Judge Irizarry:
I have known Emma Poroger for 12 years and during that time span have become good friends with her.
First of all, I would like to thank fate that I met this person. From the first moment we met, I understood
that she was a person I could put my trust in.
She did a lot of good things for me that she did not have to do. First, she helped me get a good job at a
difficult time in my life. She recommended me as a medical biller to her boss. Because of her
recommendation he offered me a position in his office which improved my career prospects. It was very
fortunate for me back then because I recently came to United States and did not know many people in
the medical field that would put their trust in me.
In 2006, my son got a severe case of Poison Ivy. It was Friday late afternoon and I called Emma for
advice. She did not even hesitate for a second and personally came to my house to give my son an
injection despite having to travel a long distance.
We worked together in VitaMed Family Practice for 3 years and later I did medical billing for her practice
and not once has she requested to over code. Now being an experienced medical biller and being
around the medical billing industry I can say that Emma Poroger was an honest doctor for whom the
main goal was to give a good care and a proper medical treatment to the patients.
I understand that in this case Dr. Poroger did not use her best judgment and she has lost a lot because of
this situation. But I really believe that this case is not a reflection of Dr. Poroger's character. She is a very
good person who has helped not only me but other people that she has come in contact with.
Your honor, I would like to ask you to be lenient with Emma Poroger.
Respectfully yours,
Elena Bronstein



My name is Denis Shtabel. I am a Sr. QA and production support IT Manager at Aetna. I have
been working at Aetna for the past 14 years. I have known Emma Poroger for 22 years. Her son Feliks
and I have been best friends since high school.
In early 90s Emma made a decision to immigrate to US, hoping for a better life and a brighter
future for her son and her family. It was a difficult decision, one that would require Emma to sacrifice
her own successful medical career in Ukraine for the better of her loved ones.
Once family settled in Brooklyn and Feliks started to attend high school, Emma went back to
school herself. She started with English classes and then applied for medical school.
It was a difficult task to start all over again, but Emma was not intimidated by it.
During late 90s when I would visit her home, I would see stacks of medical books, notes, diagrams and
English/Russian dictionaries opened and being used in every room and on every desk/table of her
house. She was immersed in studying.

For Emma to go back to school at age 40 and to graduate with a medical degree from New York
College of Osteopathic Medicine in 2000, speaks volumes about Emmas tenacity, character and
courage. Years of grueling medical school and residency, didnt break her down but instead made her
appreciate her family and her future profession even more.
She taught her son, through her own actions, that nothing comes easy in life, yet if you put your
mind and effort to it, you can achieve your goals and dreams.
Emmas innate passion for medicine and her natural calling to help people is what motivated her
to start her medical career once again from the ground up. During Emmas years of practicing medicine,
she has many patients who are thankful to her for her knowledge, her professionalism, and her ability to
listen and resolve their medical issues.

I can continue on and on writing about how much Emma means to her family and how much her
family means to Emma. I can talk about her life long struggle and success, but what I want to finish this
letter with is by writing about Emmas positive impact on those who she comes in contact with. She
would always help one in need. It can be a relative, a friend or patient of hers. She does not
discriminate. I can honestly say that, without knowing it, Emma made positive impact on decisions that
I made in my life. She has a big heart and that heart is full of love and compassion for others.

In a couple of months Emma is going to become a grandma for the first time in her life.
I can only imagine how happy and excited Emma will be when she gets to see her grandson the day he is
born. And I can also imagine how devastating it would be for her and for her family to know that she
wont be able to hold him and help taking care of him if she were to be sentenced to serve time in
prison.
I understand that Emma has pleaded guilty to a federal crime and awaits sentencing. I
understand that she made a mistake in judgement. Nevertheless, I believe that she is no threat to
society and I respectfully ask the court to be lenient and not to sentence her to jail time.

Respectfully,
Denis Shtabel.

Izabella Genin
43 Sunset Lane
Staten Island, NY 10307
izabellagenin@gmail.com
(347) 331-9795
March 27th, 2015
United State District Court
Brooklyn, NY 11201
I am asking you to accept this letter in support of Dr. Emma Poroger. I thankfully appreciate
your time and willingness to consider this letter in your decision. This letter is about one medical
professional who is asking the court to be lenient in imposing the sentence of another medical
professional.
I was a nurse from Memorial Sloan Kettering Cancer Center who devoted the last decade of her
professional life and retired from this hospital last year. I met Dr. Emma Poroger in a very
difficult time in my life. It was after a car accident with a drunk driver in which I sustained
serious injuries that greatly affected my personal and professional life. Under the devoted and
exceptional care of Dr. Poroger, I was able to continue working until my retirement time and be
free from pain in my everyday activities.
In the medical profession, we are dealing with extreme physical and emotional pain. From my
working experience, emotional pain is equally and even greater than physical pain. This pain not
only is affecting Dr. Poroger, but also her family and friends who she takes great care of. When
dealing with emotional pain you can only overcome and care with kindness, compassion, and
dignity.
Your Honor, in my 65 years of life I have seen a lot of doctors and I can assure you that the
words "devoted, humane, passionate, kind and not one to harm" are all applied to
Dr. Poroger. We all make mistakes, but not all have the decency to admit it and sincerely
apologize. I know that Dr. Poroger is truly repentant for her mistake and is deeply in pain. Her
mistake was the result of poor judgment by letting people take advantage of her good will and
unspoiled nature.
I am confident in my pleading to you Judge Irizarry for your compassion, fairness, and wisdom.
"I have always found that mercy bears richer fruits than strict justice" Abraham Lincoln
Respectfully yours,
Izabella Genin

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March 27, 2015


My name is Julianna Shtabel and Ive been employed by Insurity as a Manager of Software Engineering
in Hartford, CT since 2001. I am writing this letter on behalf of Emma Poroger.
I was introduced to Emma Poroger through my husband and his best friend Feliks Koyfman, Emmas son.
This was back in 2000 when my husband (boyfriend at the time) and I were visiting my mother-in-law in
New York and met Feliks and Emma at a quite restaurant in Brooklyn for lunch. She talked a lot about
Feliks, his accomplishments at school and his future plans. I could tell that she is very much devoted to
her family. She provided emotional support to her son during his medical school years. She kept his
spirits up during difficult times and gave valuable advice when he was at crossroads in his life.
Even though these days I dont have the pleasure of spending a lot of time with Emma, I hear many
stories about Emma from Feliks. Emma is always there for him and his wife. They are both
professionals with demanding jobs and Emma helps them with keeping up their household for which
they are very grateful to her.
Emma is a very positive and energizing person. When I think back to all the times I have been in her
company, she always had a smile on her face and found a way of making everyone around her laugh.
Even in dark times, she always kept positive.
Emma is expecting her first grandchild in June. She is very excited about it as she has been patiently
waiting to become a grandmother ever since her son was married. This is the time when Emmas
involvement and help will be invaluable to her son and her daughter-in-law. Being deprived of ability to
see her family frequently and from being involved in her grandsons life due to imprisonment will be
devastating for Emma and her family.
I understand that Emma has pleaded guilty to a federal crime and awaits sentencing. I believe Emmas
time will be more valued with her family as it continues to grow. I respectfully ask that she be spared
imprisonment.

Respectfully,
Julianna Shtabel
March 25, 2015

My name is Viktoriya Paroder and Emma Poroger is my aunt. I am an academic
radiologist and a scientist. I know that my aunt has been convicted of a crime and
that you will be sentencing her in connection with this crime. I am writing this
letter in hope that ask for your leniency in deciding on the sentence. I am asking
you to spare my aunt, Emma Poroger, of any sentence of imprisonment. I can
state with confidence that if Emma Poroger has made any mistake in judgment, it
doesnt at all reflect who she really is as a person and as a professional.
I have known Emma since I was a little girl. She is a very caring, warm, honest
and kind person. As I grew up I have come to realize that she is just as caring,
warm and knowledgeable physician. She has always strived to help people
irrespective of their background or social status. For her patients, there was no
time of the day when she was not reachable; always ready to listen, support and
help.
Emma has worked very hard ever since she arrived to this country. Needless to
say, she has accomplished a nearly impossible task of finishing medical school for
the second time at already not so young age in a foreign language. This is
something not very many physicians from foreign countries are able to achieve.
Having gone through many years of undergraduate and graduate training in this
country myself, I admire Emma for her perseverance, dedication, hard work and
strong work ethic.
For her immediate and extended family she has always been a source of endless
support, encouragement and pride. She has raised a son who is an excellent
physician. She is the primary caretaker of her elderly father. To the rest of us she
is just as kind, warm and caring aunt as she has always been. We can always turn
to Emma for advice, help and support, knowing that we will always get an honest,
sincere opinion on any issue.
Again, I am asking for your leniency in deciding Emma Porogers sentence to

spare her of any imprisonment.
I thank you for your time and attention to my letter.
Respectfully,
Viktoriya Paroder MD PhD

March 31, 2015
My name is Dr. Samuel Vasershteyn and I am a retired Dentist. I have known Dr.
Emma Poroger since she was a medical student in the Ukraine and remained good friends
with her during our difficult immigrations. Emma is a remarkable physician who I
consult when any member of my family has any sort of illness. When my father was
hospitalized a few years ago she was the first person I contacted for consultation. Dr.
Poroger immediately contacted the attending physician and helped identify an alternative
diagnosis which dictated my fathers course of treatment and helped eliminate
unnecessary testing and discomfort for my father. I credit her for minimizing my fathers
hospital stay and greatly improving his outpatient treatment plan.
Emma is an astute clinician with amazing empathy which she has demonstrated to
me when answering my clinical questions and helping me make an informed health
decision. I have remained close friends with Emma as she has struggled with the terms of
the recent conviction. She feels a void in her life without the relationships and daily
interactions she had with her patients. Emma still remains a reliable and available
resource for former patients, family, and friends when it comes to health care questions.
My family and I consider Emma a member of our family. She is a benevolent soul
and a person of high integrity and morale. She has paid for her mistakes dearly and would
like to move forward and continue contributing to her close circles and community. I
plead that you spare Emma jail time and instead allow her a more constructive approach
to correct her mistakes and rebuild her life. Emma has expressed her deep regret for her
mistakes and is actively working to make amends in her life.
Respectfully,
Dr. Samuel Vasershteyn

Emma Poroger Sentencing Memo

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Case 1:11-cr-00742-DLI Document 117 Filed 04/11/15 Page 1 of 27 PageID #: 591

UNITED STATES DISTRICT COURT

- against EMMA POROGER

MEMORANDUM IN AID OF SENTENCING

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We respectfully submit this memorandum on behalf of Dr. Emma Poroger in connection

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Devotion to Family and Friends

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Severe Health Problems

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Fall From Grace

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Second, a non-custodial sentence is sufficient, but not greater than necessary, to

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Third, a non-custodial sentence afford[s] adequate deterrence to criminal conduct. 18

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New York, New York

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March 30, 2015.

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Ieniency as possible in Emma's sentencing.

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firmly believe in Emma's strength, integrity, perseverance, and determination to

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March 18, 2015

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Igor Poroger, B.E.S., J.D.

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